Disaster Planning: Ham Radios, Alcohol Rx, and a Call to Action

Christopher Tedeschi, MD, reports on the most interesting abstracts from the WCDEM conference.

To find out about all the hallway buzz from the WCDEM conference, check out this link.

CAPE TOWN -- More than 500 research abstracts are being presented at the 19th World Congress of Disaster and Emergency Medicine (WCDEM) this week, representing a range of topics from clinical care to training and education. Here are three that caught my eye:

Ham Radio and Disaster Response

When all else fails, count on a worldwide system of amateur radio operators to get the message out.

Susan Speraw and colleagues from the University of Tennessee College of Nursing presented a qualitative survey of a small group of American amateur ("ham") radio operators -- an often overlooked and potentially critical asset in post-disaster communications.

Thousands of ham radio operators worldwide operate voluntarily, responding to disasters with communications capabilities that often remain robust after Internet connections, cell service, land lines, and satellite links have been disrupted. The researchers found that the ham radio operators are sometimes able to make lifesaving connections simply because they have the ability to pass a message along. All of the radio operators interviewed were part of a global network and had the skills to connect with colleagues rapidly during disasters -- often working without external power supplies.

Bottom line: Ham radio operators worldwide are an underutilized and critical component of disaster response systems. Emergency managers should understand what they do and integrate them into disaster plans.

San Antonio Military Medical Center EM resident Antonia Helbling discussed the results of a trial conceived after she noticed nurses in her ED using alcohol swabs to treat nausea. Helbling and her colleagues conducted a randomized, controlled trial of inhalation of isopropyl alcohol swabs as compared with similarly packaged saline swabs. After identifying patients with nausea in their ED waiting room, the researchers tested the ability of the swabs to reduce self-reported nausea scores.

Participants held the swabs to their noses and breathed deeply for 60 seconds, and then repeated the process for a total of three times over ten minutes. Seventy two percent of the patients in the treatment group had significant reduction of nausea (more than three points on an 11-point scale) after 10 minutes, versus 2.3% of subjects in the placebo group.

But given an uncertain demographic composition of the study subjects (Helbling estimates approximately 50% Caucasian, with the remainder Latino, African American, or Asian), it is difficult to tell whether some patients came to the study with a "built in" placebo effect arising from prior cultural beliefs and practices.

Bottom line: Why not give it a shot? Inhalation of isopropyl alcohol may curb nausea in ED patients, although the mechanism is unclear.

A Paucity of Research?

Of the 500 abstracts presented here at WCDEM over the past few days, a minority -- at best -- involve randomized trials or methodologically sound research that describe tests of particular interventions. This reflects the literature in general, according to Sowmya Adibhatla and colleagues from the University of Wisconsin.

The group reviewed the full text of all articles in two of the leading disaster medicine journals (Prehospital and Disaster Medicine and Disaster Medicine and Public Health Preparedness) over a 5-year period. They found that of a total of 487 articles related to disaster health, only 94 (19.1%) described studies that compared outcomes following an intervention. The majority of the interventional studies (14% of the total) were related to risk reduction. The remainder of the research that the team examined fell into epidemiological, "other," or "uncategorizable" categories -- case reports, narrative descriptions or anecdotes, or other observational research.

Bottom line: We might not know what we're talking about. The effective practice of disaster medicine demands widely accessible, evidence-based research that tries to figure out which interventions are helpful. This should be a call to action for researchers in the field.

Christopher M. Tedeschi, MD, is reporting from South Africa for the WCDEM conference. He is an assistant clinical professor of emergency medicine at Columbia University Medical Center in New York City and is actively involved in teaching wilderness and environmental medicine to residents, and serves on the education committee of the Wilderness Medical Society. Tedeschi is especially focused on the applications of wilderness medicine to international medicine and disaster response and preparedness.

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